Notice of Special Interest (NOSI): Addressing the Etiology of Health Disparities and Health Advantages Among Immigrant Populations
Notice Number:

Key Dates

Release Date:

February 6, 2023

First Available Due Date:
June 05, 2023
Expiration Date:
June 06, 2026

Related Announcements

PA-20-185 - NIH Research Project Grant (Parent R01 Clinical Trial Not Allowed)

PAR-22-145 - Leveraging Health Information Technology (Health IT) to Address and Reduce Health Care Disparities (R01 Clinical Trial Optional)

PAR-21-358 - Risk and Protective Factors of Family Health and Family Level Interventions (R01 - Clinical Trial Optional)

PAR-22-233 - Time-Sensitive Opportunities for Health Research (R61/R33 Clinical Trial Not Allowed)

Issued by

National Institute on Minority Health and Health Disparities (NIMHD)

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

National Institute on Drug Abuse (NIDA)

National Cancer Institute (NCI)


The purpose of the immigrant health initiative is to support innovative research to understand factors uniquely associated with the immigration experience that contribute to health disparities or health advantages among U.S. immigrant populations. This includes but is not limited to risk/protective factors associated with immigration processes from influences that spur migration from the sending country, through the experience of immigration, to the experience of resettlement, short- and long-term residence in the U.S. and the process of acculturation that affects the health of U.S. immigrant populations (particularly agricultural workers, first generation immigrants, and children of immigrant families). For this Notice of Special Interest (NOSI), the term "1st generation" refers to people who were born outside of the U.S. and its territories and relocated to the U.S. The term "2nd generation" refers to the U.S. born children of 1st generation immigrants.

Background and Goals

In 2022, the U.S. immigrant population was 47 million accounting for 14.3% of the population and this population is expected to almost double within the next 4 decades. Census data indicates that approximately 18% of U.S. immigrants are under 15 years of age. Immigrant families often have incomes below the federal poverty level and 41% of today's new immigrants tend to have a high school education-equivalent or less. These data do not reflect the changing situation for most immigrants as they settle into a range of communities, acculturate to different social and cultural values, food choices, employment and educational opportunities, and health challenges.

Factors associated with immigration processes—prior to and while deciding to immigrate, during the migration experience, and throughout the course of becoming accustomed to a new environment—can translate into higher risk for diseases in the face of multilevel challenges when settling into the U.S. Many immigrants also face multiple ongoing challenges, such as lower health literacy, lack of health insurance, limited English proficiency, others barriers to effective patient-clinician communication, other limitations in accessing health care as well as maintenance selected traditional health practices. Discrimination and prejudice are common and affect daily experiences with individuals and organizations within the host society. Structural factors such as local and national laws and policies, the availability of affordable housing, suitable employment, local infrastructure that hinders or facilitates mobility to jobs, schools, medical care, among other things may also impact immigrant health.

Health disparities for specific conditions among immigrant populations are well documented. Yet, most immigrant populations tend to have better health outcomes than U.S. born populations for the leading causes of death, despite the adversities they encounter. Despite numerous challenges facing 1st generation immigrants, recent immigrants have reported better health outcomes than U.S. born populations, a status that is thought to deteriorate with increasing length of U.S. residence and in subsequent generations increasing one’s risk for chronic disease. More research is needed to understand the drivers of the immigrant paradox, protective and resiliency factors, health advantages, and why later generations may experience worse health outcomes and how to sustain and promote protective factors.

Risk factors and disease outcomes also vary by immigrant subpopulations based on their country of origin; yet many studies consider immigrants as homogeneous groups according to their region of origin (e.g., Latin America, Asia, Africa), despite different languages, cultures, U.S. policies, and immigration experiences. For example, U.S. immigrants from approximately 20 Latin American countries are treated as one Hispanic/Latino group and not separated into subpopulations based on country of origin and/or ethnic group. Asians (from more than 30 countries) or Africans (from over 20 countries) are treated as one immigrant population when the health outcomes often vary by subpopulations. More research is needed to better understand the risk and protective factors unique to each immigrant subpopulation.

Most research on immigrant health does not consider factors and processes (e.g., civil unrest, financial goals, education, armed conflict, exposure to criminal violence ) that spur the migration of groups or subsets of groups from one’s country of origin. Little attention has been given to the pre-existing experiences and/or trauma (e.g., starvation resulting from rapid environmental changes, changing food sources, violent outbreaks, exposures to toxic chemicals and pesticides), and how the experience of migration itself, or how the process of adjustment and adaptation to a new cultural, social, political, and ecological environment, may affect health outcomes. Also, it is imperative to consider the receiving communities where immigrants settle and the potential effects on one’s health. Likewise, it is essential to consider the period(s) in the life course when migration occurs and how that experience may affect health outcomes.

Given current knowledge on the determinants of immigrant health, (e.g., social, environmental, behavioral, and structural) and the mechanisms driving these factors to influence health status, improve health outcomes and reduce observed disparities within these populations, more research to understand the risk and protective factors operating at multiple levels for U.S. immigrant subpopulations is necessary.

Research Objectives

This NOSI calls for multidisciplinary and multilevel research to understand the interplay of multiple factors that cause health disparities or health advantages among underserved immigrant populations and the mechanisms through which they operate. Research should focus on understanding the etiology of the health outcomes among immigrant subpopulations by targeting the complex causes or consequences of health disparities and health advantages.

Applications should include multidisciplinary research to understand the interplay of multiple factors that cause health disparities among underserved immigrant populations and the mechanisms through which they operate. Projects that examine factors at multiple levels and domains are strongly encouraged (see the NIMHD Research Framework for examples of determinants of health at different levels:

Investigators are strongly encouraged to employ a common set of tools and resources that will promote the collection of comparable data on social determinants of health (SDOH) across studies. Studies should incorporate measures from the Core and Specialty collections that are available in the SDOH Collection of the PhenX Toolkit (

Since cumulative processes across the life course at the individual, family, community, and society levels are critical for understanding health disparities and advantages among immigrants, applicants are encouraged to focus on  critical time periods and interaction with phases of the immigration process across the lifespan. Attention to premigration experiences, cultural values and related health practices, the experience of migration itself, or how the process of adjustment, adaptation and assimilation to a new cultural, social, political, and ecological environment may affect health outcomes, is encouraged. It is important to consider processes that support resilience and well-being in the lives of immigrants throughout the immigration experience that may buffer the effects of adversity. The role that ethnic enclaves, social networks, resilience, and frequent contact and visits to their native countries play in explaining some health advantages needs to be considered.

Applications are encouraged to integrate multiple approaches, such as biological assessments with consideration of sociocultural or behavioral variables and processes for better understanding of complex interactions for excess risk or resilience to health outcomes. Comparison of immigrant health factors between the U.S. and country of origin is encouraged, as is use of existing data from the country of origin, when possible, for comparison.

Projects should involve collaborations among relevant groups and organizations working with U.S. immigrant population groups, such as researchers, community leaders and organizations, public health organizations, consumer advocacy groups, faith-based organizations, and healthcare providers. As appropriate for the research questions posed, inclusion of key immigrant community members in the conceptualization, planning and implementation of the research is  required to generate better-informed hypotheses, development of measurement tools that reflect the lived experience of community members, address issues of significance to the community, and enhance the translation of the research results into relevant and sustainable practice.

Projects must include a focus on immigrants from one or more NIH-designated populations who experience health disparities in the U.S., which includes racial and ethnic minorities (Blacks or African Americans, Hispanics/Latinos, Asian Americans, and Pacific Islanders). Studies focused on exploring the immigration experience of residents of U.S. territories (Guam, Puerto Rico, American Samoa, Commonwealth of the Northern Mariana Islands, and US Virgin Islands) to the contiguous U.S. are encouraged. Please see: for more information.

Please note that exclusion of non-English speaking immigrant participants without compelling scientific justification (e.g., studies focused on second-generation immigrant youth) is discouraged and that appropriate translation services should be provided for in the research plan and the budget.

Research is encouraged among distinct immigrant subpopulations based on the country of origin, rather than larger racial/minority populations when feasible (e.g., Koreans, Vietnamese, Cambodians,  rather than Asian Americans). For projects involving comparisons across populations, these comparisons should illuminate immigrant-specific phenomena rather than represent more global comparisons between immigrants with Whites or the general U.S. population. Examples of appropriate comparisons include but are not limited to:

  • Immigrant subpopulations within the same racial/ethnic minority group (e.g., Nicaraguan immigrants vs. Mexican immigrants vs. Puerto Rican residents who migrate to the continental U.S.;
  • Immigrants across racial/ethnic minority populations sharing similar experiences in the U.S. (e.g., Southeast Asian immigrant garment workers vs. Mexican immigrant garment workers) or from the same racial/ethnic minority group that work in different labor markets (e.g., Mexican agricultural workers vs. Mexican construction workers); or
  • Immigrants with their U.S. born counterparts (Chinese immigrants vs. U.S. born Chinese Americans).

Research Topics

Specific research topics of interest associated with the immigration processes among immigrant populations in the U.S. include but are not limited to:

  • Examine the mechanisms and pathways for multiple factors influencing risk for chronic disease and comorbidities before, during the immigration process, and at the time of resettlement of immigrants
  • Explore immigration process experiences, especially how the process of adjustment and adaptation to a new cultural, social, political, and ecological environment may influence future health advantages or health disparities
  • Leverage available population data sources to understand the interplay of multiple factors that cause health disparities or health advantages among underserved immigrant populations and the mechanisms through which they operate.
  • Explore how socioeconomic status, immigration stress, social mobility within the U.S., acculturation,  and time living in the U.S. may influence health outcomes among immigrants
  • Understand multilevel, multidomain influences on health in the sending country that may spur immigration and result in health advantages or health disparities
  • Examine the interaction of social, cultural, environmental (including the familial, neighborhood, the built and natural environments and rapid environmental change), and biological factors that affect health disparities throughout the immigration process
  • Determine how factors during the immigration process influence disparities in sleep and sleep related health outcomes and health advantages in the host country among recent immigrants
  • Examine the influence of migrating as an individual, or lone family into an unknown community as compared to arriving to live within an established community of people from the same country of origin on health advantages and health disparities
  • Explore the influence of frequent contact with and returning to their native country on health outcomes
  • Investigate how exposure to stressful social environments throughout the life course, during transitional periods (prior to, during, and throughout the migration experience to the host environment), increases risk for or provides protection from diseases later in life among different U.S. immigrant subpopulations
  • Determine how toxic exposure to chemicals, occupational, residential, and other environmental stressors (including those affected by climate change) before or throughout the immigration process increases risk of comorbid diseases later in life
  • Understand how stigma impairs diagnosis and treatment of infectious diseases such as hepatitis B, hepatitis C, tuberculosis, sexually transmitted infections, and HIV and other co-occuring conditions
  • Identify social and cultural factors at individual, family and/or community levels that may support or deter resilience through the immigration experience that result in health advantages
  • Explore how local and national policies interact with social and health behaviors and its effect on health outcomes among immigrant populations
  • Investigate structural factors and institutional racism and discrimination affecting the health of immigrant populations living in different regions of the U.S.
  • Consider acculturative stress in conjunction with other stressors, such as poverty, racism, stigmatization, and discrimination affecting health outcomes among various immigrant subpopulations and migrant workers
  • Examine stress associated with the intersection of race/ethnicity, sexual/gender identification, national origin, other domains of self-identification and its influence on health
  • Identify biomarkers (e.g., allostatic load, telomere length) of cumulative immigration-specific stress that may relate to health disparities
  • Consider the integration of sociocultural factors with biological factors, specifically in the genome, epigenome, metabolome, or microbiome, through the immigration and acculturation processes due to changes in diet and lifestyle choices in their native country and the U.S. related to health
  • Explore and document the mechanisms by which risk and protective factors affect changes in co-morbid and co-occuring conditions, including substance use and other common co-occurring mental health disorders (e.g., depression, PTSD, other anxiety disorders, suicide, etc.)
  • Investigate how factors at individual, family and/or system levels impact health care-seeking behavior/communication with health care professionals
  • Examine how state or local policies may impact health behaviors and health care practices
  • Determine the influence of intergenerational family and household composition on where family members choose to seek health care and how adherence to treatment affects various health outcomes
  • Understand patterns and quality of health care for immigrants who travel back and forth from the U.S. to their native country and receive care in both countries
  • Explore health care practices and behaviors within the U.S., specifically as they interact with maintenance of traditional health care practices and health behaviors among understudied populations (e.g., Pacific Islanders)

The National Cancer Institute (NCI) coordinates the National Cancer Program, which conducts and supports research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and the families of cancer patients. NCI’s interest in this FOA centers on research directed toward understanding the relationships between environmental or occupational exposures and cancer etiology, cancer survival, and cancer control. Exposures that occur in the home country prior to immigration to the United States as well as exposures that are the result of the unique lived experiences of immigrant populations are of specific interest. Examples of environmental and occupational exposures relevant to the mission of NCI include, but are not limited to: (i) lifestyle factors; (ii) infectious agent; (iii) physical and chemical agents, and (iv) the social and built environment. Research may include investigating the interplay between these factors exposed throughout the life span as related to cancer risk and outcomes. The NCI is also interested in research that leads to the development of prevention and intervention strategies to reduce environmentally induced cancer risk.

Application and Submission Information

This notice applies to due dates on or after June 5, 2023 and subsequent receipt dates through June 8, 2026.

Submit applications for this initiative using one of the following funding opportunity announcements (FOAs) or any reissues of these announcements through the expiration date of this notice. Applicants should verify that the target Institute/Center to which they intend to apply participates in the FOA through which they will apply.

  • PA-20-185- NIH Research Project Grant (Parent R01 Clinical Trial Not Allowed)
  • PAR-22-145 - Leveraging Health Information Technology (Health IT) to Address and Reduce Health Care Disparities (R01 Clinical Trial Optional)
  • PAR-21-358 - Risk and Protective Factors of Family Health and Family Level Interventions (R01 - Clinical Trial Optional)
  • PAR-22-233 - Time-Sensitive Opportunities for Health Research (R61/R33 Clinical Trial Not Allowed)

All instructions in the SF424 (R&R) Application Guide and the funding opportunity announcement used for submission must be followed, with the following additions:

  • For funding consideration, applicants must include “NOT-MD-23-002” (without quotation marks) in the Agency Routing Identifier field (box 4B) of the SF424 R&R form. Applications without this information in box 4B will not be considered for this initiative.

Applications nonresponsive to terms of this NOSI will not be considered for the NOSI initiative.


Please direct all inquiries to the contacts in Section VII of the listed funding opportunity announcements with the following additions/substitutions:

Scientific/Research Contact

Deborah E. Linares, Ph.D., M.A.
Telephone: 301-402-2516

Crystal Barksdale, PhD, MPH
Telephone: 301-402-1366

Rada Dagher, Ph.D.
Telephone: 301-451-2187

Curt Tavis Dellavalle, Ph.D.

Tatiana Balachova, Ph.D.
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Telephone: 301-443-5726

Mary Theresa Macdonald
National Institute on Drug Abuse (NIDA)
Phone: 301-827-6239

Peer Review Contact(s)

Examine your eRA Commons account for review assignment and contact information (information appears two weeks after the submission due date).

Financial/Grants Management Contact(s)

Priscilla Grant, J.D.
Telephone: 301-594-8412

Crystal Wolfrey
Phone: (240) 276-6277

Judy Fox
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Telephone: 301-443-4707